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Hemolytic Jaundice results from increased destruction of red blood cells in circulation or the precursors of the red blood cells in the bone marrow leading to the yellowish discoloration of the eyes, skin or mucous membranes; Hemolytic jaundice is also known as Acholuric Jaundice because there is excessive amount of unconjugated bilirubin in circulation; this increased destruction of the red blood cells leads to elevated levels of bilirubin in the blood: a condition called hyperbilirubinemia. The type of bilirubin released in Hemolytic Jaundice is known as Unconjugated Bilirubin; hence when hemolytic jaundice causes hyperbilirubinemia, it is called unconjugated hyperbilirubinemia.
Unconjugated bilirubin means it is not attached to glucuronic acid yet and can only be transported in blood by binding to Albumin. Because bilirubin is not soluble in water, it means that that before it can be excreted in bile, it must be conjugated. When it is attached to glucuronic acid, it is called conjugated bilirubin. When conjugated bilirubin (now water soluble) is found in urine, it means it is not caused by hemolysis (breakdown of red blood cells).
Hemolytic jaundice is usually mild when the liver function is normal. But when the function of the liver is deranged, it makes it difficult for the liver to excrete the excess bilirubin and this causes accumulation of unconjugated bilirubin in blood and only then will Hemolytic jaundice becomes severe. Hence, in severe liver disease or in newborns (in this case, the bilirubin transport mechanism is not yet mature); the jaundice of hemolysis is severe.
Hemolytic Jaundice Causes
- Infections such as Malaria, Sepsis, Toxoplasmosis etc
- Hemoglobin abnormalities (Hemoglobinopathies) such as in sickle anemia crisis
- Cell membrane abnormalities (Membranopathies) such as Hereditary spherocytosis and hereditary elliptocytosis
- Red blood cell enzyme defects such as Glucose 6 Phosphate Dehydrogenase deficiency (G6PD deficiency)
- Autoimmune diseases
- Drugs and chemicals
Hemolytic Jaundice Symptoms and Signs (Clinical features)
- Yellowish eyes
- Absence of itching (this is what distinguishes hemolytic jaundice from one arising from liver disease or gall stones)
- Dark colored urine (due to increased excretion of urobilinogen in urine)
- Dark colored stool (due to increased excretion of stercobilinogen in feces)
- Pale looking, due to anemia
- Splenomegaly due to excessive activity of the reticuloendothelial system of the spleen. This causes enlargement of the abdomen.
Hemolytic Jaundice Investigations
- Plasma bilirubin will be elevated but usually less than 6mg/dL
- Liver function test will be normal except in a case where there is liver disease occurring in a case of hemolytic jaundice.
- Full blood count (FBC) will show evidence of hemolytic anemia
- Absent bilirubinuria because it is unconjugated bilirubin
Hemolytic Jaundice Treatment
Treatment of Hemolytic Jaundice depends on the cause; once the cause is known, it is then treated accordingly. Bacterial Infections should be treated with appropriate antibiotics and Malaria should be treated with Antimalarial drugs. Drug induced hemolytic jaundice should be treated by withdrawal of the drug. Avoid triggers for G6PD deficiency.